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Medicare Fraud Scheme at Coral Gables-based Florida Healthcare Plus Revealed

It has recently been revealed that a Medicare fraud scheme at the Coral Gables, Florida Healthcare Plus has cost the federal government $25 million in illegally obtained funds. On October 30, 2014, 8 Miami residents and 3 residents of Nicaragua were indicted in federal court for their participation in the mass Medicare fraud scheme. The scam is considered one of the first of its kind, and involved the fraudulent submission of Medicare claims by those alleging to be retired U.S. citizens living in the Dominican Republic. It is believed that almost 1,200 expatriates created fake addresses in Florida in order to enroll in Medicare through Florida Healthcare Plus. According to Assistant U.S. Attorney Eric Morales, many of these fraudsters had never even lived in Florida. With the discovery of the scheme, many of the perpetrators have been arrested, including 72-year-old doctor Santiago B. Montoya of Miami, who was the face of the Medicare fraud scheme.

The Coral Gables-based Scheme

Given Florida’s status as the fraud capital of the U.S., it should come as no surprise that new and innovative medical healthcare fraud schemes continue to emerge almost weekly. This Medicare fraud scheme was operated at an international level and commenced by the ringleader Pedro Hernandez, the former chief operating officer of Florida Healthcare Plus. From 2011 through 2014, Hernandez, along with the company’s marketing director, spent 2 years signing up retirees from Nicaragua and the Dominican Republic so that they could receive Medicare health benefits. Florida Healthcare Plus operates under the Medicare Advantage private plan, and received around $10.5 million in federal payments for beneficiaries that they recruited from the Dominican Republic and Nicaragua.

In addition to utilizing Florida Healthcare Plus to perpetuate the scheme, other South Florida-managed healthcare companies were allegedly exploited as well. Advertisements in local newspapers and on the internet were used to lure Nicaraguan and Dominican Republican expatriates to participate in the fraud. The main targets of the fraud were retired Americans, native Nicaraguans who settled in the United States to escape persecution during civil war, and American retirees living in the Dominican Republic. Florida Healthcare Plus went so far as to fly patients to Miami to create fake addresses for residency establishment, and to also undergo Medicare health evaluations. After returning to Latin America, Montoya and other unlicensed foreign doctors would provide follow-up treatments.

Apparently, many of the expatriates in the scheme did not fully understand that fraud was occurring, and that they were being exploited and misled. In fact, in order to induce expatriates to sign up for Medicare, the fraudsters misrepresented that U.S. Medicare benefits were accessible in both the Dominican Republic and Nicaragua.The U.S. Department of Health and Human Services’ Office of Inspector General, the Federal Bureau of Investigation (FBI), and the Diplomatic Security Service have led this ongoing investigation. The defendants stand accused of conspiracy to commit wire fraud and health care fraud, an assortment of separate health fraud counts, conspiracy to defraud the U.S. government, and counts of making false statement related to health care related matters.

Fraud-related charges come with serious consequences. If you need legal representation in a Medicaid fraud dispute or for any other federal case, contact criminal defense attorney Jeffrey S. Weiner, P.A., in South Florida today.

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